Healthcare Provider Details

I. General information

NPI: 1376996165
Provider Name (Legal Business Name): ROCIO BANDERA DE WILLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 8911
NEWPORT BEACH CA
92658-0911
US

IV. Provider business mailing address

123 S BRADLEY RD APT C
SANTA MARIA CA
93454-5335
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-1321
  • Fax:
Mailing address:
  • Phone: 805-540-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: